Why this is not done!

[reaper]

This is why you do not lay Pt's face down! Epic fail!

http://www.ems1.com/ems-management/...ambulance-company-caused-mother-to-suffocate/

By John O'Brien
The Post-Standard

FULTON, N.Y. — Oswego County sheriff’s deputies handcuffed a combative, hallucinating woman behind her back to protect her from herself when they responded to a suicide attempt at her home in 2006.

Dorothy Caniff, 42, of Fulton, was strapped face down on a gurney after Menter Ambulance workers arrived May 25, 2006, according to police reports.

In the ambulance, Caniff went into cardiac arrest and died at A.L. Lee Memorial Hospital, in Fulton. A medical examiner ruled that she died because of the position she'd been placed in: prone, arms behind her back and strapped onto the gurney.



This should be covered in EMS 101.

 

[MrBrown]

...Ambulance workers ....

There's a new one

 

[JPINFV]

"Girl friend's gonna get paid!"

[youtube]http://www.youtube.com/watch?v=9SwQtVsRXsc[/youtube]

 

[mycrofft]

Odd, I was just reading up on positional asphyxia yesterday .

Multiple elements involved in these sorts of cases:
1. Prone patient (this limits respiration from the git-go).
2. Arms pinioned (secured in back) which limits tidal movement.
3. Vicious cycle of struggling subject-kneel on subject to subdue-anoxic subject struggles more-more pressure or restrain applied. Increasing metabolic demands throw pt into panic, then collapse.
4. Often the subject is intoxicated and/or wrecked from drug abuse already and so more prone to meltdown.
5. Obesity (you're shoving guts and fat into the tidal volume space and the pt is porbably cardiovascularly compromised already).
6. Claustrophobia can lead to the struggle/smother cycle above.

So called "recovery position" or "semi-recumbent" does not have these drawbacks. I've seen more people die of airway embarassment AFTER/due to being placed supine (soft tissue, secretions, blood, vomit and anything else fall back into the upper airway). But then you have to consider spinal immob....
Follow your protocols, and use your eyes and ears to tell you when the pt NEEDS some real airway assistance. Practice EFFECTIVELY clearing airways on immobilized pts, and if LE or you have effectively immobilized anyone, take immediate and continuous care of their status.

 

[46Young]

Me personally, if the LEO has to put someone under, and handcuff them to the cot (not prone, of course) I prefer to be given the officer's key which I place in my shirt pocket. The officer rides in the cruiser behind the bus. Upon arrival, the officer gets the key back. I don't like there being a gun within reach of an EDP/perp, especially within an enclosed space.

 

[spinnakr]

Me personally, if the LEO has to put someone under, and handcuff them to the cot (not prone, of course) I prefer to be given the officer's key which I place in my shirt pocket. The officer rides in the cruiser behind the bus. Upon arrival, the officer gets the key back. I don't like there being a gun within reach of an EDP/perp, especially within an enclosed space.

This won't be a problem if you know the officer, but how do you go about explaining it to the LEO? (I'm not trying to be confrontational; I'm just curious).

Also, this is yet another reason why a backboard sandwich is an inappropriate means of restraint.

 

[Shishkabob]

So, excited delirium?

 

[Veneficus]

So, excited delirium?

no such thing

 

[JPINFV]

Sounds more like positional asphyxia.

 

[JPINFV]

This won't be a problem if you know the officer, but how do you go about explaining it to the LEO? (I'm not trying to be confrontational; I'm just curious).

A better option would be to transfer the patient to restraints made for medical patients. All ambulances should have a set of leather restraints on them.

 

[spinnakr]

A better option would be to transfer the patient to restraints made for medical patients. All ambulances should have a set of leather restraints on them.

That was my thought too - but I'm still curious. I'm not sure how most officers I know would feel about giving up their keys...

 

[CAOX3]

Oy Vey!

Fired.

And no one gets handcuffed in my ambulance unless a cop is riding.

 

[Hal9000]

Well, that's an ultimate facepalm. I met some EMTs who wanted to put metal scoop stretchers over their patients to "calm them down," after which I pointed out the, well, flaws in their plan. They decided it would be best to roll the patient into a prone position and then apply the metal scoop. This website does not really have appropriate emoticons for this sort of thing.

 

[dmc2007]

That was my thought too - but I'm still curious. I'm not sure how most officers I know would feel about giving up their keys...

That and we're not trained or get any practice in quickly removing handcuffs.

 

[spinnakr]

That and we're not trained or get any practice in quickly removing handcuffs.

Well, most of us. Some might have had handcuff experience before... but hopefully from other jobs! (for the record, that was a joke).

You bring up a very good point, though.

 

[DrParasite]

interesting...... the ambulance company isn't exactly denying that it was done, only that they aren't responsible because it was the sheriff's deputies that restrain the patient, and placed them in that position, not the EMS people.

I find this to be even more interesting:

Blake is not suing the Oswego County Sheriff’s Department. Kenny said the evidence indicates deputies did nothing wrong. They had to restrain Caniff because she was combative, he said.

So the Sheriff's who actually did the restraining don't get named? usually when a lawsuit happens, it's like a shotgun, shoot at everyone and let them fight it out in court.

question for all involved: when dealing with violent EDPs who are restrained using police issued restraints, do the LEOs have overall control of the scene and restraint placement, as well as positioning of the violent person, or is that responsibility given to EMS?

 

[Sasha]

Well, most of us. Some might have had handcuff experience before... but hopefully from other jobs! (for the record, that was a joke).

You bring up a very good point, though.

or the bedroom.

 

[CAOX3]

or the bedroom.

Bad girl.........

 

[spinnakr]

or the bedroom.

Like I said, from other jobs.

Parasite, I'd say that ultimate control over a patient lies with EMS, and ultimate control over a detainee lies with LEO's. It's up to you to decide which is which.

 

[DrParasite]

Parasite, I'd say that ultimate control over a patient lies with EMS, and ultimate control over a detainee lies with LEO's. It's up to you to decide which is which.

So again, I ask, the patient is restrained using LEO tactics by LEOs who are using LEO equipment. So, who is in charge of how the LEO's place the patient, or how they apply the LEO restraints?

or let me be even more specific, if the LEO's handcuff the patient with their arms behind their back, are you within your rights to tell them to restrain them another way? you can ask, but what right to you have to tell a LEO how to restrain a person, when they are the experts in restraining, and have received many hours in how best to restrain someone for everyone's safety?

now, assuming they place this violently combative person in a prone position on the stretcher, and then straps the person down in hopes of limiting the patient's ability to swing and kick, what right do you have to tell the LEO anything else? after all, they are the experts in restraining, and have received many hours in how best to restrain someone for everyone's safety.

We all know EMS can ask for a LEO to do something to make out jobs easier, but if they refuse, then what position does that leave EMS in, esp when their actions are not done in the best interests of good patient care?